Ch.2 Leadership & Managment Flashcards
Nurse Practice Acts
Laws that control and regulate nursing practice in each state. To protect public from harm.
Which state has there own nurse practice acts?
All of them.
What is the main goal of the nurse practice acts?
To protect the public.
What do each of the states mandatory practice acts generally agree on?
Only licensed professionals can practice nursing.
Where do laws affecting regulation of nursing vary?
From state to state.
The nurse practice acts govern the nurses responsibility determining what with the staff?
Making assignments.
Each state sets its own what when it comes to nursing?
Educational and examination requirements.
How are assignments by the nurse usally tested on the NCLEX?
Usually determining what can be delegated to who.
What should you take into consideration when assigning tasks?
The skill level should be appropriate to the skill being delatored.
Ex. Lpn could be delegated placing a catheter but not a cna.
Who does the nurse supervise?
Care provided by unlicensed assisted personnel. UAP
What kind of procedures must be delegated to or supervised by an RN?
Invasive procedures or sterile procedures.
Documenting client care is consider what?
A legal task.
Define unintentional torts?
An act involving injury or damage to another (except beech of contract) resulting in a civil liberty. ( the victim can sue.)
Negligence
Performing an act that a reasonable and prudent person would not.
How do you measure negligence?
Would a reasonable nurse act in the same manner under the same circumstances.
Malpractice
Negligence by professional personelle that results in injury.
Example of malpractice?
Professional misconduct or unreasonable lack of skill in carrying out professional duties.
When could negligence occur?
Unreasonable lack of skill and preforming it anyway.
What are the four elements necessary to prove malpractice?
Duty
Breach of duty
Injury/Damages
Causation
When can malpractice not be proven?
If one of the four elements can’t be proven.
Duty
Obligation to do what a reasonable nurse would do; failure to protect others from foreseeable risk.
What do we mean that a nurse has to anticipate foreseeable risk?
If a floor is wet the nurse must anticipate a clients fall.
Breech of duty
Failure to perform according to the established standard of conduct.
Injury/Damages
Failure to meet standard of care which causes actual injury or damage. (Physical injury).
What kind of injury is not enough to prove malpractice?
Emotional or mental injury is enough to prove malpractice.
Causation
A connect exist between conduct and the resulting injury.
How do hospitals provide a guide for nursing actions?
Policies ; not laws, but courts generally rule agianst nurses who have violated the employers policies.
When can hospitals be held liable?
Poorly formulated or poorly implementation.
How can nurses avoid negligence and malpractice?
By following their organizations policies and procedures.
Incident reports
Alert the administration to possibility liability claims and the need for investigation.
What do incidents reports not protect you from?
Legal action against negligence or malpractice.
What are some examples of negligence or malpractice?
Burning a client with a heating pad.
Performing incompetent assessments .
Ignoring Sighns
Forgetting to give medications , or giving the wrong medication.
Intentional torts
______
Assault
Mental or physical threat (forcing [without touching] a client to take a medication or treatment.]
Battery
Actual or intentional touching of one another, with or without the intent to cause harm.
What is an example of battery?
A mentally competent adult is forced to have a treatment he or she has refused.
Invasion of Privacy
Encroachment or trespassing on another’s body or personality.
False imprisonment
Confinement without authorization.
Exposure of a persons body?
After death a person has the right not to be looked at or touched.
Exposure of a persons personality?
Exposure or discussion of a persons personal information or communication.
Fraud
When someone purposefully misrepresents info that can harm someone else.
Defamation
Divulgence of privligaed information or communication.
What are examples of fraud?
Presenting false credentials.
Describing a myth regarding treatment. - telling someone that a treatment has no side effects.
Crime
You know a crime.
When does a person comit a crime?
A deed done contrary to criminal law.
What is criminal about refusing to help delever a baby?
When you are legally obligated , and the child gets hurt it is a crime.
When does criminal consouracy occur?
When two or more people agree to comit a crime.
When are you equally guilty in a crime?
Knowingly giving aid or assisting in it.
When is ignoring a crime illegal?
You see another nurse taking drugs or alcohol and not reporting it while on the job.
If you see a nurse stealing narcotics and ignore it what are you doing?
Committing a crime.
What do you need before searching a persons property?
Search warrants.
If you suspect abuse what must you do?
Report it even if your not sure.
When is assault justified ?
For self defense.
When using assault for self defense what must it be?
Only enough force to maintain self protection.
How guilty are you if you assist in any crime?
Equally as guilty
Civil procedures
Methods used to help protect the rights of psychatric patients.
Voluntary admission
The client admits themselves for treatment and retains civil rights.
Involuntary Admission
Someone other then the client applies for admission.
What do you have to have for an Involuntary admission?
Certification from a healthcare provider the person is in danger to their self or others. Some states require two doctors.
Individuals with involuntary admission have the right to what?
Legal hearing within a certain number of days.
Most states limit involuntary admission to how long?
90 days.
How long can involuntary commitment be?
Usually less than a year.
Who can admit another for emergency admission?
Any adult may apply for emergency admission of another. But to be held longer than 24 hours you need medical or judicial approval.
What can a person being held agianst there will do?
File a writ of habes corpus to try to get the court to hear the case and let them go.
Who determines the sanity and alleged unlawful restraint of a person?
The court.
What are six civil rights help by a hospitalized patient?
- Wear own clothes
- Right to individual storage space
- Right to see visators daily.
- Reasonable access to a telephone
- Right to send/receive mail.
- Right to refuse shock treatment and lobotomy’s.
Competency hearing?
No hearing that is held to determine a persons ability to make responsible decisions.
People declared incompetent have a legal status of?
A minor
People declared incompetent have the legal status of a minor they cannot do what?
Vote Make contracts or Wells Drive a car Sue or be sued Hold a professional license
Who can declare a person incompetent?
The state or the family.
Insanity
Legal term meaning the accused is not criminally responsable for the unlawful act committed be they are mentally ill.
What are three reasons someone cannot stand trial?
- Cannot understand charge
-
How do you identify a patient?
With two patient identifiers. Name and date of birth.
What may not be used as an identifier?
Patient room number.
Who sets the two patient identifiers?
The joint commission.
What must you get to perform surgery?
Surgical permit - no matter how minor the surgery.
Legally what must the surgical permit be?
Written
Obtained volentary
Explained to the client.
What does informed consent mean?
The procedure and treatment or operation has been fully explained to the client.
What must be included in informed consent?
Possible complications, risks, and disfigurations.
What’s being removed And where parts of body
Benefits and expected results.
How must surgery permits be obtained ?
Witnessed by an authorized person ; healthcare provider or nurse.
How do surgery permits protect the client?
Agianst unsanctioned surgery.
How do surgery permits protect the healthcare provider?
Possible claims of unauthorized operations.
Who can sighn there own operative permits? What must they be?
Adults and emancipated minors ; that are mentally competent.
Who do you need to get consent from for a unconscious adult or minor child?
Parent or guardian.
What do you need to make descision for someone who can’t make their own descisions?
Durable power of attorney or an advanced directive
HESI hint: who should explain and describe the operative procedure?
The health care provider. It is not the nurses responsibility.
HESI Hint: when it comes to operative permits what is the nurses job?
Make sure the permit is sighned and is in the clients medical record.
HESI hint: what must the nurse document when it comes to surgery permits?
Document the client was given information and agreed to it.
Does the law always require written consent to perform medical procedures?
Not always.
When don’t you need a written consent to preform a medical procedure?
- client has been fully informed.
- volentary consent from client.
- immediate treatment is needed to save life or limb.
How do obtain verbal consent?
Make a notation that :
- describes in detail why verbal consent was given.
- it is placed in the clients record or chart.
- it is witnessed and sighned by two persons.
How can verbal or written consent be given?
Alert, coherent, or otherwise competent adults.
- a parent or legal guardian
- a parent with loco paretitis.
Loco parentis
A person standing in for a parent with all the rights of a parent.
How must you get consent with minors?
Minors 14 years of age or older must agree to treatment with there parents.
How do you get consent from rmanacipated minors ?
They can consent in there own.
What should you be careful with emancipated minors?
The definition of emancipation changes from state to state.
Good Samaritan Act
Protects health care providers against malpractice claims for care provided in emergency situations.
HESI Hint: when are you as a nurse protected under the Good Samaritan act?
When a nurse is performing EMERGENCY care.
What does a nurse need to carry out medical procedures ?
Obtain a doctors order/prescription.
What kind of doctors orders should be avoided?
Telephone prescriptions.
When taking a telephone doctor order what must you do says the joint commission?
Follow the process of a read back of critical values.
How should the telephone prescription be written?
On the patients chart. And read it back bitch!
What should the nurse do if they question a healthcare providers order because they think it is wrong?
- Tell the healthcare provider.
- Record you informed the healthcare provider.
- Inform nursing supervisor.
- Refuse to carry out the doctors order/prescription.
What should the nurse do if the feel the doctors order was made with poor judgment?
- Record that you told the healthcare provider, and that the prescription was questioned.
- Carry out the order ( a nurse clinical judgment cannot be substituted for a healthcare providers judgment).
What should you do if you do not feel prepared or feel like you don’t have enough expaeriance performing a skill?
- Tell the healthcare provider.
2. Refuse to perform the skill.
HESI Hint: When is a nurse responsible for harm to a patient?
When they perform a skill they don’t feel comfortable with and did not tell the provider.
HESI hint: who is in trouble if the nurse is uncomfortable with a skill, and they inform the healthcare provider?
Nurse and healthcare provider.
Can you ever alter the amount of a prescribed drug without a doctors say so? Why or why not?
No because a nurses clinical judgment is better than the doctors.
What are the only three circumstances a client may be restrained?
- In an emergency.
- For a limited time.
- For the purpose of protecting the client from injury or harm.
What are the two main nursing responsibilities with restraints?
Must notify healthcare provider immediately!
Accurately document the situation that lead to the restraints.
When, only, should you use restraints?
After exhausting all other reasonable alternatives.
Ex. Calling family, try to figure why they are acting that way.
How should restraints be applied?
Correctly in accordance with the facilities policies and procedures.
How often should you check restraints? What should you look for?
Frequently: 4 hrs for adults, 2 for kids 9-17, and every hour 9 or less.
Look to not impair circulation or cause pressure ulcers, or injuries.
When should you try to remove restrains?
ASAP
What should you never do to a restrained person?
Leave them alone.
What three things should be documented for restraints?
Need for application.
Monitoring.
Removal of restraints.
HESI Hint: what can restraints of any kind be?
False imprisonments.
What should you folllow when using restraints?
Guideline of state law and hospital policy.
What is HIPAA?
Health Insurance Portibility and Accountabity Act.
When was HIPAA passed?
1996
Why was HIPAA created?
To create national patient record privacy standard.
Who does HIPAA apply to?
Everyone.
What do you need to diclose any patient rights for almost any purpose?
Written patient consent.
When using patients medical information what must the nurse provide the patient?
Detailed information of how the information will be used.
What must patient be able to do with there health information?
Be able to access it at all times.
How severe is it to break HIPAA?
It is a criminal offense.
Where can you find more information about HIPAA?
Department of health and human services.
Quiz 1
Quiz 1
Section one cards 1-122 took 2.5 hours the become fluent.
Section one cards 1-122 took 2.5 hours the become fluent.
Nurses are consider to be what of the medical office/nursing home?
Leaders and Managment roles.
Leader
Influences people to accomplish goals.
Manager
Works to accomplish the goals of an organization.
Nurse manager
Acts to achieve the goal of safe, effective client care.
What are the skills of a nurse manager?
Communication Organization Delegation Supervision Critical thinking
What are the characteristics of a nurse manager?
Authority Accountability Responsibility Leadership Commitment meant to quality
HESI Hint: what is the job of a nurse leader?
Provide an environment that will promote motivation through seeking feedback , respect, and seeking input.
HESI Hint: How will the HESI test content on nurse leadership and Managment?
Selecting nursing interventions that show these qualities of a nurse manager.
What are nurse managers responsible for adressesing?
Workplace violence Nursing staff substance abuse Incivility and bullying. Inappropriate nurse client-situations Bad use of social media.
What is an illegal example of nurse incivility or bullying?
Refusing to share important information about a patients stats that results in the patient getting hurt.
If you see a staff member perform something wrong what do you have to do?
Show them the appropriate way or behavior.
What are three chartistics of assertive behavior?
Clearly defined goals
Congruent verbal and nonverbal messages.
Critical in directing.
HESI Hint: assertive commhnication is?
I need , rather than, “you must”
What are the three main things we as nurse ?
People
Time
Supplies
What outlines the authority, accountability, and responsibility of a nurse?
Nurse Practice Acts
Delegation
As asigning duties, tasks, and coordination.
Even if you delegar a task to do one else’s what is important to keep in mind?
The nurse is still responsible and accountable for the quality of the tasks assigned.
Responsibility
Obligation to complete a task.
Authority
The right to command actions.
Accountability
Assume accountability for own actions.
Since you are still accountable for what you delegate, what must you make sure is being met?
The five rights of delegation.
What are the five rights of delegation?
Right task Right circumstance Right person Right direction/communication Right supervision
HESI Hint: what does delegation require?
What should you ask yourself?
The nurse to be awhere of the qualifications of the delegee:
———-
Do they have the right training, skills, education.
HESI Hint: What are the steps of the nursing process?
ADPIE
Assessment Diagnosis Planning Implementation Evaluation
HESI Hint: can you delegate the nursing process to a nurse aide?
Nope.
What step of the nursing process is delegation found?
Implementation.
HESI Hint: What are the two main procedures uap are not allowed to perform?
Invasive or sterile procedures.
HESI Hint: If a nurse aide fucks up, are you responsible at all?
Yes.
When giving directions and guidance what five things need to be done?
Clear concise Expected outcome Time frame Limitations Verification of assignment
How should you evaluate and monitor?
Frequently check in
Open communication lines
Achievement of outcome
How should you follow up with tasks assigned to LPNs or UAP?
Communicate the findings and the achievement of those findings.
Why sometimes do you need to follow up with the ST N/A or LPN?
There may be a need for guidance or teaching.
What are the three basic aspects of supervision when delegating the RN is accountable for?
Direction – guidance
Evaluation of monitoring
Follow up
Who is the RN accountable for when delegating?
LPN, graduate nurses, and experienced nurses, student nurses, and UAP
What is the main model nurses are accustomed to using to solve a problem and client care situations?
The nursing process: ADPIE
What is the nursing process?
Add pi
Assessment
What are the needs or problems
Analysis
What has the highest priority.
Planning
What outcomes and goals must be accomplished.
What are the available resources.
Implementation
Communicating expectations
Is documentation complete
Evaluation
Were the desired outcomes achieved?
Was safe, effective care provided?
HESI Hint: What clients deserve priority?
Ask yourself the following:
Which client is the most critically ill and unstable?
Which client is most likely to experience a significant change?
Which client requires assessment by an RN?
Who should a client that has an infection not be roomed with?
Someone who is immunocompromised.
If a client is a Highfall risk where should they be roomed?
Closer to the nursing station.
What are three skills needed by change agents?
Problem-solving
Decision-making
Interpersonal relationships
HESI Hint: What does change cause?
Anxiety
What does an effective nurse agent do to deal with change that causes anxiety?
Use problem-solving skills to recognize factors such as anxiety that contribute a resistance to change and his decision making and interpersonal skills to overcome the resistance
What are some interventions that demonstrate skills when dealing with change that causes anxiety?
Seeking input, showing respect, valuing opinions, and building trust.
Lewins change theory
Unfreezing: initiation of change
Moving: motivation toward a change
Refreezing: implementation of a change
What do you interprofessional healthcare teams require?
Shared goals, commitment, and accountability
Open and clear communication
Respect for the expertise of all team members.
Critical pathways
Interprofessional plans of care that are used to diagnose and care that can be standardized guides to track client progress
Do you critical path ways replace individualized care?
No
Case management
Coordinates care provided by interprofessional team using critical pathways to organize care
DISASTER NURSING
DISASTER NURSING
What is the role of the nurse at all three disaster Managment?
Disaster preparededness
Disaster response
Disaster recovery
How do achieve effective nuring amnagmnet?
Organization is key
All personel must be trained
All personel must know there roles.
What are three levels in disaster Managment?
Primary prevention
Secondary prevention
Tertiary prevention
What is primary prevention?
Development of a disaster plan
Train resucue workers in triage and basic first aide
Educate personnel about shelter Managment
Educate the public about disaster plan and perdónele.
What is secondary prevention?
Triage
Treatment of injuries
Treatment of other issue - including mental health.
Shelter supervision
What is tertiary prevention?
Follow up care for injuries
Follow up psychological problems
Recovery assistance
Prevention of future disasters
What does triage mean?
A french word meaning to sort or categorize.
What is the goal of triage?
Maximize the number of survivors by sorting the injured according to treatable and untreatable victims.
What are the two thing you think when trying to triage?
Do they need the most care.
Do we have enough stuff.
How is triage used?
A systematic approach such as simple method START.
